IU School of Medicine visit to expand genetic research capability in Kenya

By Kevin Fryling

It’s nearly 8,000 miles from Kenya to Indianapolis. That’s a long distance to ship a regular package, let alone a delicate parcel that could contain the clue to helping someone survive one of the most difficult forms of breast cancer.

Yet that’s just one of many challenges faced by four scientists from Kenya who traveled to the IU School of Medicine from Sept. 10 to 14 to learn about its advances in the field of specimen storage and biobanking. The visit is the first step in expanding the ability to collect, store, annotate and ship medical samples from volunteers at the AMPATH reference lab at Moi Teaching and Referral Hospital, the primary teaching hospital for Moi University. The university is a close partner of the IU School of Medicine in the IU-Kenya Program and AMPATH, or Academic Model Providing Access to Healthcare.

“This was an immersion visit; there’s a great deal to learn,” said Thomas Inui, M.D., co-director of research for AMPATH, director of research for the IU Center for Global Health and executive committee member of the Indiana Clinical and Translational Sciences Institute. “They came to see our biorepository; to understand its standard operating policies and procedures; and to learn about the information systems that support biomaterials storage and sharing.”

The visiting scientists included Nathan Buziba, M.B., Ch.B., director of the AMPATH reference lab and chair and senior lecturer of pathology at Moi University; Wilfred Emonyi, manager of the AMPATH reference lab; Kritika Patel, a pathologist and lecturer in immunology at Moi University; and Alice Mudogo, technician at the AMPATH reference lab.

“IU’s been in this business for a long time, so we’re coming here to learn how you do it,” Dr. Buziba said. “Right now we’re not as organized or as centralized in our sample storage and collection as we want to be. We want to get the right standard operating procedures in place so our samples as good as anyone else’s – for a sample from Eldoret to be no different than a sample from IU.”

Biorepositories contain samples such as bloodspots, biopsies and frozen materials such as plasma, all usable for DNA extraction. The need to increase the ability to collect and store these materials both at the IU School of Medicine and in Kenya – as well as exchange them – relates to larger shifts in biomedical research in Indiana and across the globe.

“This is the direction in which science is moving,” Dr. Inui said. “Because of the burgeoning science of genomics and the powerful effects of genes and gene products on disease and diagnosis and treatment, the areas of personalized medicine and individual diagnostics are being seen more and more as the leading edge of science. Our partners in Kenya are part of the IU health science campus – and just as we don’t fall behind the state of science, they don’t either. However, we need to invest in training and resources to bring them up to our level of functioning.”

In Eldoret, Dr. Emonyi said most research samples are maintained and controlled by the scientist using them in their work. This means material can “fall through the cracks” after it’s no longer needed for a study.

“It’s very researcher-controlled right now,” Dr. Emonyi said. “We’re even seeing cases where materials are left to break down after a project is complete. After they’re done, what should be done with these things? That is the challenge.”

One solution could be a shared-resource model such as the type used by the Indiana Biobank, which requires scientists and patients to agree that their contributions may be shared with other approved researchers as a prerequisite of using the facility.

In addition to the Indiana Biobank, the visiting scientists met with leadership from the Komen Tissue Bank at the IU Simon Cancer Center, the National Cell Repository for Alzheimer’s Disease and the Indiana CTSI, which manages the Indiana CTSI Specimen Storage Facility. The CTSI facility is responsible for the Indiana Biobank, Komen Tissue Bank and NCRAD, as well as other biorepositories across campus. Other visits included meetings with James W. Smith, M.D., Nordschow Professor Emeritus of Laboratory Medicine and consultant to the AMPATH reference lab, and Barbara Van Der Pol, Ph.D., MPH, assistant professor of kinesiology at the IU School of Public Health-Bloomington and consultant to the AMPATH clinical lab. The AMPATH reference lab focuses on sample analysis for research purposes, whereas the clinical lab focuses on sample analysis for medical treatment.

“The Indiana CTSI Specimen Storage Facility may be one of the best examples of a well-functioning biorepository,” Dr. Inui said. He noted that other groups contributing consultation and advice to the Kenyan Biobank initiative include AMPATH Consortium member University of Toronto and the Wellcome Trust, a British foundation that supports research facilities in sub-Saharan Africa.

Support for the establishment of a Kenyan Biobank will ultimately include funds from Susan G. Komen for the Cure, which provided $500,000 for the collection of breast tissue samples in Kenya. Collection is scheduled for summer 2013, with some samples remaining in Eldoret and others being shipped for storage in the Komen Tissue Bank.

The tissue samples collected could shed light on triple-negative breast cancer, one of the most difficult-to-treat forms of the disease. The condition, named for the hormone receptors involved in the disease, is the most common form of breast cancer in Kenya, despite its being distinctly uncommon in the United States. Moreover, Dr. Inui said the remarkable genetic diversity in Africa, due in part to the continent’s status as the birthplace of humankind, makes it an ideal place to collect genetic information on cancer and other diseases.

The Kenyan scientists' visit was supported in part by the IU Center for Global Health, which will also sponsor a future trip to Kenya by experts from the Indiana CTSI biorepository.

“Many threads were woven together for this particular visit,” Dr. Inui said. “What comes out of it will be a true roadmap for the development of a biobank in Kenya.”

James W. Smith, M.D., Nordschow Professor Emeritus of Laboratory Medicine at the IU School of Medicine and consultant to the AMPATH reference lab, collaborates with Nathan Buziba, M.B., Ch.B., director of the AMPATH reference lab and chair and senior lecturer of pathology at Moi University.

The Specimen Storage Facility, managed by the Indiana Clinical and Translational Sciences Institute, maintains more than 60 freezers for biomaterials for the Indiana Biobank, the Komen Tissue Bank at the IU Simon Cancer Center and the National Cell Repository for Alzheimer’s Disease, among other projects.